Anticholinergic Premedication for Flexible Bronchoscopy: A Randomized, Double-Blind, Placebo-Controlled Study of Atropine and Glycopyrrolate. Chest [Chest] Journal article | | Title | Anticholinergic Premedication for Flexible Bronchoscopy: A Randomized, Double-Blind, Placebo-Controlled Study of Atropine and Glycopyrrolate. | | Author(s) | Malik JA, Gupta D, Agarwal AN, Jindal SK | | Institution | From the Pulmonary Medicine (Dr. Malik), SKIMS Medical College, Srinagar, India; and the Department of Pulmonary and Critical Care Medicine (Drs. Gupta, Agarwal, and Jindal), Postgraduate Institute of Medical Education and Research, Chandigarh, India. | | Source | Chest 2009 Mar 24. | | Abstract | Background Anticholinergic premedication is commonly used during flexible bronchoscopy, although benefits are unproven and potential risks exist. Methods We studied 1000 patients undergoing diagnostic flexible bronchoscopy to investigate the efficacy and safety of atropine and glycopyrrolate. Patients received atropine (0.01 mg/kilogram; n = 339), glycopyrrolate (0.005 mg/kg; n = 336), or placebo (2 mL normal saline; n = 325), intramuscularly before bronchoscopy in a randomized, double-blind fashion. Bronchoscopist- and patient-reported secretions, cough, and patient discomfort, oxygen desaturation, procedure time, and procedure-related adverse events were compared between the groups. Results After adjusting for covariates, glycopyrrolate (p = 0.02), but not atropine (p = 0.064), was associated with reduced bronchoscopist-reported airway secretions. Neither drug was independently associated with patient-reported airway secretions or with bronchoscopist- or patient-reported cough or discomfort. Neither drug was independently associated with oxygen desaturation. Atropine was associated with a longer procedure time (p = 0.042). Rise in heart rate and BP was significantly greater with anticholinergics, particularly atropine, as compared to placebo. Conclusions Anticholinergic premedication may reduce airway secretions during flexible bronchoscopy but is not associated with any significant reduction in cough, patient discomfort, oxygen desaturation, or procedure time and is associated with greater hemodynamic fluctuations. Routine anticholinergic premedication may be unnecessary or even harmful during flexible bronchoscopy. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19318667 |
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